Commercial (Dental) Advanced Claim Processor (TEMPORARILY REMOTE - MILWAUKEE)

Location: Milwaukee, Wisconsin, United States

Notice

This position is no longer open.

Remote Opportunity: 1

Requisition Number: 3600

Position Title: Claim Processor Advanced

External Description:

 Advanced Claim Processors may specialize in one or more of DentaQuest’s business units and process advanced and complex claims with 99% or greater accuracy using DentaQuest’s proprietary claim processing software.

PRIMARY JOB RESPONSIBILITIES:

  • Consistently process advanced & complex claim queues with a 99% or greater accuracy rate.
  • Uses business knowledge to independently resolve advanced claim processing scenarios including, but not limited to, COB (coordination of benefits), ORTHO (orthodontia) cases, TPL (third party liability), and manual pricing.
  • Make adjustments to complex claims, as necessary, to meet corporate goals.
  • May serve as back up to call center during peak periods by taking member and provider calls to ensure corporate-wide service levels are consistently achieved.
  • Serve as back up to Claim administration team by processing adjustments, posting check refunds and completing follow ups.
  • Serve as back up to Claim Research and Resolution team by researching and resolving claim issues.
  • May serve as back up to Team Lead in daily reporting.
  • Successful completion of more complex projects, as assigned. Other duties as needed or required.

JOB QUALIFICATIONS:

Required:

  • Associates degree Four years’ experience in a business environment.
  • Strong math competency.
  • Previous claim processing experience required.
  • Attention to detail, accuracy and organization skills are essential.
  • Understanding of general insurance principles.
  • Ability to efficiently operate computer.
  • Strong interpersonal, written and verbal communication skills.
  • Self-motivation demonstrated by taking initiative to learn more and assume new challenges.
  • Cooperative, professional and effective interaction skills with co-workers, business partners and visitors.
  • Ability to work in excess of 40 hours in one week.
  • Ability to use Microsoft Office. (Word, Excel and Outlook)
  • Able to follow verbal and written instructions.
  • Ability to read and comprehend at a high school level.
  • Ability to communicate in an active office environment.
  • Ability to sit for more than 90% of an 8 hour day.
  • Ability to use basic office equipment.
  • Ability to communicate via telephone or computer technology, via written and verbal channels.
  • Other duties as needed or required.
  • Required to attend additional training as requested/deemed necessary.

PHYSICAL DEMANDS:

  • Incumbent must be able to communicate effectively.
  • Requires overall light physical effort (up to 25lbs.)
  • Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal computer).
  • Ability to travel or move about within and outside serviced facilities required.
  • Incumbent works primarily in either a private or shared office environment
Internal Description

JOB SUMMARY: Advanced Claim Processors may specialize in one or more of DentaQuest’s business units and process advanced and complex claims with 99% or greater accuracy using DentaQuest’s proprietary claim processing software.

PRIMARY JOB RESPONSIBILITIES:

  • Consistently process advanced & complex claim queues with a 99% or greater accuracy rate.
  • Uses business knowledge to independently resolve advanced claim processing scenarios including, but not limited to, COB (coordination of benefits), ORTHO (orthodontia) cases, TPL (third party liability), and manual pricing.
  • Make adjustments to complex claims, as necessary, to meet corporate goals.
  • May serve as back up to call center during peak periods by taking member and provider calls to ensure corporate-wide service levels are consistently achieved.
  • Serve as back up to Claim administration team by processing adjustments, posting check refunds and completing follow ups.
  • Serve as back up to Claim Research and Resolution team by researching and resolving claim issues.
  • May serve as back up to Team Lead in daily reporting.
  • Successful completion of more complex projects, as assigned. Other duties as needed or required.

JOB QUALIFICATIONS:

Required:

  • Associates degree Four years’ experience in a business environment.
  • Strong math competency.
  • Previous claim processing experience required.
  • Attention to detail, accuracy and organization skills are essential.
  • Understanding of general insurance principles.
  • Ability to efficiently operate computer.
  • Strong interpersonal, written and verbal communication skills.
  • Self-motivation demonstrated by taking initiative to learn more and assume new challenges.
  • Cooperative, professional and effective interaction skills with co-workers, business partners and visitors.
  • Ability to work in excess of 40 hours in one week.
  • Ability to use Microsoft Office. (Word, Excel and Outlook)
  • Able to follow verbal and written instructions.
  • Ability to read and comprehend at a high school level.
  • Ability to communicate in an active office environment.
  • Ability to sit for more than 90% of an 8 hour day.
  • Ability to use basic office equipment.
  • Ability to communicate via telephone or computer technology, via written and verbal channels.
  • Other duties as needed or required.
  • Required to attend additional training as requested/deemed necessary.

PHYSICAL DEMANDS:

  • Incumbent must be able to communicate effectively.
  • Requires overall light physical effort (up to 25lbs.)
  • Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal computer).
  • Ability to travel or move about within and outside serviced facilities required.
  • Incumbent works primarily in either a private or shared office environment

City: Milwaukee

State: Wisconsin

Community / Marketing Title: Commercial (Dental) Advanced Claim Processor (TEMPORARILY REMOTE - MILWAUKEE)

Company Profile:

We believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.

Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it. 

To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.

The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.

Company Profile Job:

At DentaQuest, we believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.

Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it. 

To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.

The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.

Location_formattedLocationLong: Milwaukee, Wisconsin US

CountryEEOText_Description: In accordance with our Compliance Plan, employees must conduct business in accordance with applicable laws, regulations, professional standards and ethical standards and report potential compliance or ethical issues to manager or Compliance Officer. Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please see Human Resources for additional information regarding this Program. Equal Employment Opportunity Statement: We are committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, or sexual orientation.

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